The Power of Images for Prognosis: A Rare Inferior Vena Cava Mass in a Patient With Atypical Symptoms of Heart Failure

Inferior vena cava (IVC) syndrome is a cluster of symptoms that occur due to obstruction or stenosis of the inferior vena cava. Symptoms include lower extremity swelling and erythema, shortness of breath, and abdominal discomfort. This case describes a patient who presented for evaluation of lower extremity swelling and weakness associated with nausea and vomiting. A plan was made to investigate a cardiopulmonary etiology; however, the initial bedside ultrasound that included the evaluation of the abdomen discovered a mass in the IVC and left kidney. Additional imaging and intervention that involved a posterior radical nephrectomy and IVC thrombectomy allowed confirmation of left renal cell carcinoma (RCC) extended into the IVC with a thrombus causing the constellation of symptoms. A detailed history is always important to configure the IVC syndrome, but a quick and easy bedside ultrasound can identify IVC and other abdominal pathologies. A multidisciplinary approach is highly recommended for optimal results.